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DASA Complaint

To learn more about the District's DASA Policy, click here.

To submit a DASA complaint for Saugerties Junior High School, submit the form below.

Required

Dignity for All Students Act Complaint Form
- Saugerties Junior High School -

Please be advised that upon submitting this form, it will be automatically forwarded to the alleged target students' Dignity Act Coordinator(s), listed below.

Dignity Act Coordinators:

  • Ginger Vail, Princpial, Saugerties Junior High School - gvail@saugerties.k12.ny.us
  • Anna Millenson, SSW, Saugerties Jr. High grades 7-9 - amillenson@saugerties.k12.ny.us

 

Today's Daterequired
Must contain a date in M/D/YYYY format
Reporter's Namerequired
First Name
Last Name
Email Address
Name of School:required
Reporter's Contact Information: required
Home Phone, Cell Phone, and Address
Is the Reporter:required
If you answered "other" in the question above - please specify below.
Alleged Target (Vistim/s) Name:required
Alleged Target (Victim/s) Gender:
Alleged Target (Victim/s) Grade:
9, 10, 11, or 12
Alleged Offender/s Name:required
Alleged– Offender/s Gender:
Alleged– Offender/s Grade/Position:
Was Alleged Offender arequiredChoose one
Choose one
School where the offerder attends/works:required
Witness/es Name/s and Contact Information:
If multiple, list all witness/es and their contact information

Incident Description of Discriminatory and/or Harassing Behaviors

Type of bias - based on the person’s actual or perceived:Choose all that apply.
Choose all that apply.
Description of Incident:required
What did the alleged offender(s) say or do? Include cyber evidence if possible.
What happened right after the incident occurred?
Date of Incident:
Time of Incident:
Location of Incident
Is there a history of conflict between those involved?
If you answered yes to the question above, please explain:
Have you reported this behavior before?
If you answered yes to the question above - When? To Whom? & What was done?

Please review your form for completion and accuracy, then click SUBMIT below.

Submissions will be addressed during regular school hours. If you submit a DASA complaint after school hours, on the weekend, or on break, it will be addressed the following school day.

If it is an emergency and/or concern for safety please contact the police at 911.